| NPI | 1164475265 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP113742) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 733515) | 
| Enumeration Date | 2006-05-18 | 
| Last Update Date | 2023-07-20 |